Communication of insurance claim data

ABSTRACT

Aspects of the invention are directed to methods and systems for efficiently communicating data between an insurer and a non-referral repair shop, e.g., vehicle repair shops that are normally not preapproved by the insurer to perform the estimating and repair work. The methods and systems described herein are particularly useful for insurers utilizing non-referral repair shops for servicing vehicles involved in insurance claims. According to aspects of this invention, the insured may be able to select a non-referral repair shop, not delegated or preapproved by the insurer, thereby generally allowing the insured to select any available vehicle repair shop.

CROSS REFERENCE TO RELATED APPLICATIONS

This Application is a continuation of U.S. application Ser. No.13/729,835 filed Dec. 28, 2012, which is a continuation of U.S.application Ser. No. 13/601,019, filed Aug. 31, 2012, issued Sep. 3,2013 as U.S. Pat. No. 8,527,305, which is a continuation of U.S.application Ser. No. 13/150,969, filed Jun. 1, 2011, issued Sep. 11,2012 as U.S. Pat. No. 8,265,963, which is a continuation-in-part of U.S.application Ser. No. 12/250,325, filed Oct. 13, 2008, issued Nov. 13,2012 as U.S. Pat. No. 8,311,856, wherein the entire disclosure of eachapplication is herein incorporated by reference.

A portion of the disclosure of this patent document contains materialwhich may be subject to copyright protection. The copyright owner has noobjection to the facsimile reproduction by anyone of the patent documentor the patent disclosure, as it appears in the Patent and TrademarkOffice patent file or records, but otherwise reserves all copyrightrights whatsoever.

FIELD OF THE INVENTION

The invention relates generally to insurance. More specifically, theinvention provides methods and systems for providing a vehicle insuranceclaim management application (VICMA) that will improve communication andstreamline tasks between a vehicle repair shop and an insurance companyin three general task groups: assignment management (comprising workrequest, estimates/photos, and reinspections), financial management, andperformance measurement. The invention also provides interoperabilitywith different types of repair estimating systems. The invention ispreferably accessed by a user over a computer network such as theInternet.

BACKGROUND

Vehicle repair shops and insurance companies can gain efficiencies andimprove quality of service by interoperating electronically to exchangedata and documents such as repair requests, estimates, photos,authorizations, invoices, and payments. Some claim-handling systems usedby insurance companies can support such interoperability with repairshop systems, known as estimating systems.

An insurer claim-handling system is typically designed to work with aspecific brand of estimating system, thus requiring vehicle repair shopsto use that brand to interoperate with the insurance company. Differentinsurance companies may specify or require the use of differentestimating systems, which means that vehicle repair shops wanting tointeroperate with or perform repairs for two or more insurance companiesmay have to purchase and maintain two or more estimating systems. Thecosts of purchasing, using, training, maintaining, and supportingmultiple systems are inefficient for any vehicle repair shop and can beprohibitive to smaller vehicle repair shops that would otherwise want towork with multiple insurance companies.

BRIEF SUMMARY OF THE INVENTION

The following presents a simplified summary of the invention in order toprovide a basic understanding of some aspects of the invention. Thissummary is not an extensive overview of the invention. It is notintended to identify key or critical elements of the invention or todelineate the scope of the invention. The following summary merelypresents some concepts of the invention in a simplified form as aprelude to the more detailed description provided below.

To overcome limitations in the prior art described above, and toovercome other limitations that will be apparent upon reading andunderstanding the present specification, the present invention isdirected to methods and systems for providing a vehicle insurance claimmanagement application (VICMA) that will improve communication andstreamline collaboration between the vehicle repair shop and aninsurance company in three general task groups: assignment management(comprising work requests, estimates/photos, and reinspections),financial management, and performance measurement. The invention alsoprovides interoperability with different types of estimating systems.

Additionally, the present invention is directed to methods and systemsfor efficiently communicating data between an insurer and a non-referralrepair shop, e.g., vehicle repair shops that are normally notpreapproved by the insurer to perform the estimating and repair work.The methods and systems described herein are particularly useful forinsurers utilizing non-referral repair shops for servicing vehiclesinvolved in insurance claims.

A first aspect of the invention provides one or more computer storagemedia storing computer readable instructions that, when executed,provide a vehicle insurance claim management application (VICMA). TheVICMA comprises an adapter module and a non-referral module. The adaptermodule may be defined by the computer readable instructions.Additionally, the adapter module may translate data between theapplication and a vehicle repair estimating system. The non-referralmodule may also be defined by the computer readable instructions. Thenon-referral module may receive a set of assignment data from aninsurance company pertaining to a plurality of work requests submittedto a non-referral vehicle repair shop. The non-referral vehicle repairshop may not be included within a pre-approved shop network associatedwith the insurance company. Additionally, the non-referral module mayreceive a set of estimate data from the non-referral vehicle repair shopand determine whether the non-referral repair shop is in a staffedmarket or a non-staffed market. Further, the non-referral module maydetermine a rules-based intelligence score based on the estimate data,wherein the rules-based intelligence score is defined as low-range,mid-range, or high-range. The non-referral module may also determine anintervention level for the estimate based on the rules-basedintelligence score and whether the non-referral repair shop is in thestaffed market or the non-staffed market. The intervention level mayinclude an automatic approval level, a desk adjuster level, and a fieldadjuster level. Furthermore, if the estimate data has a low-rangerules-based intelligence score, the intervention level is the automaticapproval level and the non-referral module may approve the estimatedata. Additionally, if the estimate data has a mid-range rules-basedintelligence score, the intervention level is the desk adjuster leveland the non-referral module may transfer the estimate data to a deskadjuster for a desk review and the non-referral module may furtherreceive one of an approved estimate data from the desk adjuster or adisapproved estimate data from the desk adjuster. Also, if the estimatedata has a high-range rules-based intelligence score and thenon-referral repair shop is in a staffed market, the intervention levelis the field adjuster level and the non-referral module may transfer theestimate data to a field adjuster for a field review and thenon-referral module may further receive one of the approved estimatedata from the field adjuster or the disapproved estimate data from thefield adjuster. In addition, when the estimate is not approved, thenon-referral module may allow the adjuster to create a “review” or“change” request which may be electronically sent to the non-referralrepair shop. The non-referral repair shop may respond electronically tothe review request.

A second aspect of the invention further includes the above describedaspect of the VICMA with a financial module that stores, captures,and/or provides payment status information for the vehicle repair claimsassigned to the non-referral vehicle repair shop.

Another aspect of the invention further includes the above describedaspect of the VICMA with a performance module that stores, captures,and/or provides performance metrics for the non-referral vehicle repairshop as compared to other vehicle repair facilities, both referralvehicle repair shops and non-referral vehicle repair shops, working withthe insurance company. The performance metrics may be stored and/orcaptured by the insurance company. In an embodiment of the invention,the performance metrics may not be shared with the non-referral repairshops.

Another aspect of the invention is a method for a vehicle insuranceclaim management application (VICMA) for use with a non-referral vehiclerepair shop. The method comprises a number of steps. First, the VICMAreceives a set of assignment data from an insurance company pertainingto a plurality of work requests submitted to a non-referral vehiclerepair shop. Next, the VICMA receives a set of estimate data from thenon-referral vehicle repair shop. The VICMA then determines whether thenon-referral repair shop is in a staffed market or a non-staffed market,determines whether the estimate is original or supplement, anddetermines if the assignment is a conversion. Next, the VICMA calculatesand determines a rules-based intelligence score based on the estimatedata. Following the determination of the intelligence score, the VICMAdetermines an intervention level for the estimate based on therules-based intelligence score and the staffed market and non-staffedmarket, estimate version and assignment type, wherein the interventionlevel includes an automatic approval level, a desk adjuster level, and afield adjuster level. The VICMA then approves the estimate data if theestimate data has a low-range rules-based intelligence score and theintervention level is the automatic approval level. Also, the VICMAtransfers the estimate data to a desk adjuster for a desk review if theestimate data has a mid-range rules-based intelligence score and theintervention level is the desk adjuster level and further receiving oneof an approved estimate data from the desk adjuster or a disapprovedestimate data from the desk adjuster. In addition, when the estimate isnot approved, the non-referral module may allow the adjuster to create a“review” or “change” request which may be electronically sent to thenon-referral repair shop. The non referral repair shop may respondelectronically to the review request.

Next, the VICMA transfers the estimate data to a field adjuster forfield review if the estimate data has a high-range rules-basedintelligence score and the non-referral repair shop is in a staffedmarket and the intervention level is the field adjuster level andfurther receiving one of the approved estimate data from the fieldadjuster or the disapproved estimate data from the field adjuster. Inaddition, when the estimate is not approved, the non-referral module mayallow the adjuster to create a “review” or “change” request which may beelectronically sent to the non-referral repair shop. The non referralrepair shop may respond electronically to the review request.

In addition to the above aspect of the invention, the VICMA may alsotrack a real-time financial status for the repair. The VICMA may alsocompile a set of vehicle repair shop performance data.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention and theadvantages thereof may be acquired by referring to the followingdescription in consideration of the accompanying drawings, in which likereference numbers indicate like features, and wherein:

FIG. 1 illustrates a system architecture for implementing one or moreillustrative aspects of the invention;

FIGS. 2A and 2B illustrate a flowchart of the methodology forimplementing one or more illustrative aspects of the invention;

FIG. 3 is an illustrative system overview for one or more aspects of theinvention;

FIGS. 4-16 show illustrative screen shots for one or more aspects of theinvention;

FIG. 17 illustrates a flowchart of the methodology for implementing oneor more illustrative aspects of another embodiment of the invention; and

FIG. 18 is an illustrative system overview for one or more aspects ofthe embodiment illustrated in FIG. 17.

DETAILED DESCRIPTION OF THE INVENTION

In the following description of the various embodiments, reference ismade to the accompanying drawings, which form a part hereof, and inwhich is shown by way of illustration various embodiments in which theinvention may be practiced. It is to be understood that otherembodiments may be utilized and structural and functional modificationsmay be made without departing from the scope of the present invention.

Aspects of the invention provide a method and system for efficientlycommunicating data between an insurer and its repair shops, e.g.,vehicle repair shops. An insurer may thus provide claim data to thevehicle repair shop, and the vehicle repair shop may provide repair costinformation to the insurer. In one embodiment, the methods and systemsdescribed herein are particularly useful for insurers utilizing directrepair partners for servicing vehicles involved in insurance claims.Direct repair refers to a process whereby an insured takes his or hervehicle directly to a repair shop (referred to herein as a direct repairpartner) without having to first visit an insurance adjustor to assessdamage to the vehicle. Direct repair partner shops are typicallypreapproved by the insurer to perform the estimating work directly onpremises, thereby reducing the insurer's expense of hiring insuranceadjustors and maintaining physical premises in which adjustors performtheir jobs, and saving the insured's time by not requiring the insuredto visit an insurance adjustor prior to visiting a repair shop or,alternatively, by not having to visit numerous vehicle repair facilitiesto secure multiple estimates for submission to the insurer. Thecommunicated data may include repair estimates, photos, data regardingthe insured party and/or vehicle, other data that may be used by avehicle repair shop, data obtained by a vehicle repair shop that issubsequently provided to the insurer, financial data associated with thevehicle repair shop and its repairs, performance data for the vehiclerepair shop, or reinspection reports from the insurance company. Theterm “photos” may refer to photos in a variety of formats, includingprint or digital.

FIG. 1 illustrates one example of a network architecture and dataprocessing device that may be used to implement one or more illustrativeaspects of the invention. Various components 103, 105, 107, and 108 maybe interconnected via a network 101, such as the Internet. Othernetworks may also or alternatively be used, including private intranets,local LANs, wireless WANs, personal PANs, storage area networks (SANs),and the like. The components may include an insurance company dataserver 103, web server 105, and a client computer 107. The insurancecompany data server 103 provides overall control and administration ofdata communication services according to aspects described herein. Theinsurance company data server 103 may be connected to the web server 105through which users interact with the communicative system and software.The web server 105 may be for example a claim processing system whichmay be used to store assignment information for further processing andthen translate this information into a format acceptable for the clientcomputer 107. Alternatively, the insurance company data server 103 mayact as a web server itself and be directly connected to the Internet.The insurance company data server 103 may be connected to web server 105through the network 101 (e.g., the Internet), or via some other network.

Users may interact with the data server 103 using a remote computer 107located on premises of a vehicle repair shop 108. The remote/clientcomputer 107 may be any conventional data processing device that canaccess the Internet, e.g., laptop computers, desktop computers,ultra-mobile PCs, Internet enabled mobile devices, etc. Client computersmay also be located in any other location, and need not be limited tothe premises of a repair shop. Client computers may interact with dataserver 103 and/or web server 105, e.g., using a web browser to connectto the data server 103 via one or more externally exposed web siteshosted by web server 105. Alternatively, each client computer 107 mayhave a “thin client” installed thereon, whereby the thin client providesan executable shell hosting a browser-window therein. The thin clientthereby limits the toolbar menus (e.g., File, Edit, View, Favorites,Tools, Help, etc.), such as are typically found in browser applicationssuch as Microsoft's Internet Explorer, that are available to a userwhile accessing the data server. The thin client also adds new toolbarmenus to provide services in conjunction with the data server 103 and/orweb server 105, as is further described below.

Servers and applications may be combined on the same physical machines,and retain separate virtual or logical addresses, or may reside onseparate physical machines. FIG. 1 illustrates but one example of anetwork architecture that may be used, and those of skill in the artwill appreciate that the specific network architecture and dataprocessing device used may vary, and are secondary to the functionalitythat they provide, as further described below.

Each component 103, 105, 107 may be any type of known computer, server,or data processing device. Data server 103, e.g., may include aprocessor 111 controlling overall operation of the data server 103. Dataserver 103 may further include RAM 113, ROM 115, network interface 117,input/output interfaces 119 (e.g., keyboard, mouse, display, printer,etc.), and memory 121. Memory 121 may further store operating systemsoftware 123 for controlling overall operation of the data server 103,control logic 125 for instructing data server 103 to perform aspects ofthe invention as described herein, and other application software 127providing secondary support or other functionality which may or mightnot be used in conjunction with aspects of the present invention. Thecontrol logic 125 may be referred to herein as the data server softwareor repair shop communication (RSC) software. Functionality of the dataserver software may refer to operations or decisions made automaticallybased on rules coded into the control logic, or made manually by a userproviding input into the system.

Memory 121 may also store data used in performance of one or moreaspects of the invention, including a claim database 129 and a shopdatabase 131. The claim database 129 may store information regardingclaims submitted by the insurer's insureds. Claim information mayinclude, e.g., a date of accident, type of vehicle, insured's name, etc.The shop database 131 stores information about the various vehiclerepair shops 108 with which the insurer works to repair customers'vehicles. The shop database 131 may store, for each vehicle repair shop108, shop contact information, available services (e.g., body shop,engine, transmission, audio/video, etc.), hours of operation, as well asindicate whether each shop is a direct repair partner or whether reviewby an insurance adjustor is required. In some embodiments, the claimdatabase 129 and shop database 131 may be stored in a single databasesystem. That is, the information can be stored in a single database, orseparated into different logical, virtual, and/or physical databases,depending on system design.

Those of skill in the art will appreciate that the functionality of thedata server 103 as described herein may be spread across multiple dataservers or data processing devices, for example, to distributeprocessing load across multiple computers, to segregate transactionsbased on geographic location, insurer, insured, type of insurance, etc.In addition, one or more aspects of the invention may be embodied incomputer-usable data and computer-executable instructions, such as inone or more program modules, executed by one or more computers or otherdevices. Generally, program modules include routines, programs, objects,components, data structures, etc. that perform particular tasks orimplement particular abstract data types when executed by a processor ina computer or other device. The computer executable instructions may bestored on one or more computer readable media such as a hard disk,optical disk, removable storage media, solid state memory, RAM, etc. Aswill be appreciated by one of skill in the art, the functionality of theprogram modules may be combined or distributed as desired in variousembodiments. In addition, the functionality may be embodied in whole orin part in firmware or hardware equivalents such as integrated circuits,field programmable gate arrays (FPGA), and the like. Particular datastructures may be used to more effectively implement one or more aspectsof the invention, and such data structures are contemplated within thescope of computer executable instructions and computer-usable datadescribed herein.

Vehicle Insurance Claim Management Application (VICMA)

Generally, the vehicle insurance claim management application (VICMA)improves communication and streamlines tasks between a vehicle repairshop and an insurance company in three general task groups: assignmentmanagement (comprising work requests, estimates/photos, andreinspections), financial management (e.g., electronic funds transfers(EFT)), and performance measurement. A work request also may be referredto as work assignment, repair request, service request, record transfer,vehicle claim or other terms. Whatever term is used, it is not meant toimply any particular type of relationship or obligation between theinsurance company and a vendor.

FIGS. 2A and 2B illustrate a method for the VICMA for use by aninsurance company and a user of a computer system at a vehicle repairshop. The method of FIGS. 2A and 2B will be described further in thefollowing exemplary embodiment.

FIG. 3 illustrates the insurance company system 300, a claim processingsystem 320, and the repair shop work station 107 from FIG. 1. Theinsurance company system 300 may include the claim database 129 and shopdatabase 131 as well as a security system 302. In addition, the claimprocessing system 320 may include a claim processing web server 105, atranslator application 322, and an additional database 324. The repairwork station 107 may include the VICMA 330 as described further in thisdescription. Within the repair shop work station 107, there may also bea claim processing desktop application 332 and a web-browser/insurancecompany shop application 340. While the shop application 340 isillustrated conceptually as residing at the repair shop workstation 107,the shop application 340 may alternatively be accessed by and interactwith the claim processing desktop application 332 using a web browser orbrowser shell/window. That is, the shop application 340 may be housed orserved by web server 105 associated with claim processing system 320,and merely accessed using a thin client claim processing desktopapplication 332. Within the web-browser/insurance company shopapplication 340 the user may perform a number of different actions suchas: authentication or login 342, pre-load assignment data 344, transferestimates and data 346, view insurance company estimates 348, view EFTdetails 350, view Key Performance Indicators (KPI) 352, or viewreinspection details 354. Furthermore, there may be a repair estimatingsystem 334 within the claim processing desktop application 332. Thefollowing sections will further describe the interaction between each ofthese systems and applications.

The VICMA 330 may comprise a number of modules which may include, but isnot limited to, the following: an adapter module 336, an assignmentmodule 326, a financial module 339, and a performance module 337. Eachof these modules will be described in more detail in the below sections.

Assignment Module

The insurance company may offer assignments to the vehicle repair shopfor either repairs or estimates as part of the first notice of loss(FNOL) process. After the vehicle repair shop has been offered theassignment and submitted the estimate, the vehicle repair shop typicallycompletes the corresponding repairs upon approval by the insurancecompany and absent any special circumstances. The present invention mayprovide the vehicle repair shop with assignment data needed to prepare arepair estimate or repair the vehicle. Assignment data may include, butnot be limited to, customer name, contact information, insurance claimnumber, assignment date, loss date, loss type, loss type detail, lossdescription, current vehicle location, location where vehicle may besent, deductible amount, vehicle type, year/make/model, vehicleidentification number (VIN), license plate number, towing companyinformation, damage information, prior damage information, and vehiclesafety status (drivable/non-drivable). One of the elements of the VICMAand the “direct connection” with the vehicle repair shop is the abilityto provide assignment information and to offer real-time updates whenany of the information changes during the course of the claim and/orrepair. For example, an assignment might not have contained a deductibleamount or a correct deductible amount at the initiation of theassignment. Through further investigation, the amount of the error couldbe discovered or corrected and the assignment information could beimmediately updated to the vehicle repair shop that needs that data toconclude the repair and the associated financial processing. In otherwords, the VICMA and “direct connection” with the vehicle repair shopmay expedite the repair for the customer.

An assignment module 326 may be defined by computer readableinstructions from the VICMA 330. The assignment module 326 may comprisethree functions: work requests, estimates/photos, and reinspections. Inone embodiment of the present invention, in a first step 202, theinsurance company system 300, as part of the assignment module 326,transfers (the term “transfer,” as used throughout, refers to uploadingand/or downloading and/or pre-loading, depending on the specificsituation, between two or more software applications residing on one ordifferent computers or computer systems) a set of assignment datapertaining to a plurality of work requests. The work requests arereceived by the vehicle repair shop through the VICMA and the assignmentmodule 326. A work request may be referred to by other terms such aswork assignment, repair request, service request, record transfer,vehicle claim or other terms. Whatever term is used, it is not meant toimply any particular type of relationship or obligation between theinsurance company and a vendor. The assignment data may be stored in aclaim processing system database 324. The specific claim information isassigned to a given vehicle repair shop 108 and may be transferred tothe vehicle repair shop 108 after the vehicle repair shop identity isauthenticated by the VICMA 330.

Authentication or login 342 may be accomplished when the vehicle repairshop 108 enters a name and a password in the claim processing desktop332 which queries the security application 302 to verify identity. Thesecurity application 302 may then query the shop database 131 or asimilar database (e.g., which manages the relationships between theinsurance companies and service providers to promote competition andprovide customers with fact-based recommendations). The query of theshop database 131 may then validate that the user is legitimate whileidentifying the user's level of access to the insurance companyinformation.

Once the vehicle repair shop 108 is authenticated to the insurancecompany system 300 and the user is successfully logged in to the VICMA330, in a step 204, the claim processing server 105, as part of theassignment module 326, transfers the assignment data to a vehicle repairestimating system 334. This may include transferring the claim filesassigned to the vehicle repair shop 108 by the insurance company. Theclaim processing system 320 may transfer or pre-load data 344 into theshop application estimating database by extracting information from theinsurance company data and populating the necessary fields in the shopdatabase 131 or claims database 129, while generating an assignmentrequest. The assignment request may include information about the claimand the estimate.

The next step, a step 206, the VICMA 330, through an adapter module 336,may transfer and translate the assignment data (e.g., estimate) to andfrom the vehicle repair estimating system 334. There are two differentscenarios where this may take place. First, if the customer's vehiclewas inspected by the insurance company (e.g., drive-in, etc.), thevehicle repair shop 108 may receive the estimate as part of thetransferred claim file. The estimates may then be directly transferred346 to the vehicle repair shop's estimating system 334 for furtherprocessing. The processing may include viewing and verifying theestimate 348 or modifying and sending a revised estimate through theclaim processing system 320 back to the insurance company system 300.

Second, in the case where the customer goes directly to the vehiclerepair shop 108, the vehicle repair shop 108 creates an estimate. Oncethe estimate is created, the vehicle repair shop 108 provides theinsurance company system 300 with the estimate by transferring theestimate 346 through the claim processing system 320 where it may betranslated through an adapter module 336 into a form acceptable by theinsurance company. The adapter module 336 is defined by the computerreadable instructions from the VICMA 330. The VICMA 330 may have one ormultiple adapter modules 336 which translate data between the VICMA 330and a first or second (or third, etc.) vehicle repair estimating system334. If the vehicle repair shop 108 is using a different estimatingsystem 334, then the claim processing system 320 may translate theassignment data (e.g., claim and estimate data) into a format acceptedby the vehicle repair shop's claims system. The claim processing system320 may translate this data using a translation application 322 withinthe claim processing system 320. Different vehicle repair shops 108 mayuse different estimating systems 334. The translation application 322will translate the output and input into each of these differentestimating systems 334. The VICMA 330 allows vehicle repair shops 108 touse whatever estimating systems 334 they choose. The claim processingsystem 320 may also encrypt the data transmitted over the internet toprotect the privacy of the customer and to ensure the information issecure.

In the next step, 208, the estimate data may then be sent to the VICMAfrom the vehicle repair estimating system. The assignment module 326 maytransfer the estimate data and assignment data from the vehicle repairestimating system 334 and then assign a corresponding repair to thevehicle repair shop 108.

In the next step, 210, the VICMA may then review the estimate data forcompliance with a set of front-end business rules. These front-end rulesare normally contract-based. The VICMA may review the estimate data withrespect to charges aligning with the contract the vehicle repair shopsigned with the insurance company. These contract-based features mayinclude labor rates, chargeable hours per particular task, or any otheraspect of the work covered by the contract. If the front-end rules arenot met, the vehicle repair shop 108 normally corrects the errors andresubmits the assignment request for further processing to the insurancecompany. This review could also include a review of the assignment databy the VICMA 330.

Following the estimation process and after the vehicle repair shop 108has completed the review based on the front-end rules in step 210, theestimate data or assignment data may be reviewed by a set of back-endrules by the insurance company system 300. Generally, if the estimatedata does not meet the back-end rules, a reinspection is required.During the reinspection, the VICMA, through the assignment module, mayrerun the same set of front-end rules executed at the vehicle repairshop, and may also run a set of back-end rules (BERs). Front-end rulesare normally contract-based. The VICMA may review the estimate withrespect to charges aligning with the contract the vehicle repair shopsigned with the insurance company. These contract-based features mayinclude labor rates, chargeable hours per particular task, or any otheraspect of the work covered by the contract. If certain errors are found,the insurance company system 300 may send the estimate back to thevehicle repair shop 108 to correct and re-submit. Or also, if a certainother set of errors are found, the insurance company system 300 maycorrect the identified errors and then move on and evaluate the back-endrules.

The back-end rules, as reviewed in step 212, may be based on or indicatewhether the estimate aligns with the damage described (e.g., in the caseof a front-end collision, the system would flag a rear tail lightassembly indicated as needing repair). Each discrepancy may be scoredand at the end of the review, a final score is calculated. Depending onscore thresholds, the back-end business rules define what furtherspecific action should be taken.

Example

BER<50—PASS; the claim is cleared for further processing;

BER>50—generate report and send file to reinspection for output review

The reinspection scores may be used as part of a performance ratingmethod that measures the accuracy and effectiveness of the vehiclerepair shop 108 relative to others in the market. The reinspectionscores are then tabulated and may be displayed and stored using areinspection report.

The insurance company system 300 may create a reinspection report. In astep 214, the VICMA 330 may receive a set of inspection data from theinsurance company. This inspection data may be in the form of thereinspection report. The reinspection report may include: claim number,owner name, estimate version, appraisal source, reinspection type,reinspection location, reinspector's name, repair phase, reinspectioncompletion date, and reinspector notes.

In a step 216, a read-only copy of the reinspection report may bedownloaded and reviewed 354 by the vehicle repair shop 108 by linkingthrough web browser on the claims processing system desktop application320. If discrepancies are listed in the reinspection report, the vehiclerepair shop 108 then transfers a change request form through the claimsprocessing translator system 322 which will allow the vehicle repairshop 108 to enter corrected information using its estimating system 334.In a step 218, the VICMA updates the estimate data based on thereinspection and reinspection report. Once the data is corrected, asupplement shop estimate may be transferred to the insurance companysystem 300 via the claim processing translator system 322. The finalfinancial processing on completion of repairs, EFT, might not processuntil all required reinspection requests are corrected and supplementshop estimates are transferred to the insurance company.

The change request form may also include additional quality informationin the form of: estimate accuracy percentage, opportunity percentage,dollar accuracy, and dollar opportunity in terms of a percentage ofcosts.

Examples

Estimate Accuracy (%)=(Insurance Company estimate value/Shop estimatevalue)×100%Opportunity (%)=100%−Estimate Accuracy %Dollar Accuracy (USD)=Insurance Company Estimate (USD)×EstimateAccuracy/100Dollar Opportunity (USD)=Shop Estimate−Dollar AccuracyEstimate accuracy may be defined by the ratio of the insurance companyestimate divided by the vehicle repair shop estimate. When the shopestimate is more than the insurance company estimate, the value is lessthan 100%. However, if the vehicle repair shop estimate is less than theinsurance company estimate, the value is greater than 100%.

The reinspection report may also include estimate exceptions. Estimateexceptions may highlight information associated to the claims that areidentified by the insurance company as being in error. The types ofinformation that may be highlighted may include vehicle information(vehicle year, mileage, equipment level). Other exceptions may includeestimate line items. Estimate line items include listing of parts, laborand associated task duration (hours), and price. The reinspection reportmay also include a summary section that tabulates the identified tasks,hours, associated labor rates, and total amount of the reinspectioncosts. This information may also or alternatively be used by theperformance module 337 and/or the financial module 339.

Financial Module

In a step 220, the VICMA 330 provides the capability to track real-timefinancial status of the vehicle repair through the use of a financialmodule 339 or an Electronic Funds Transfer (EFT) system. The financialmodule 339 tracks two different types of claim transactions:verification requests and payment remittance. The financial module 339provides for transaction information to be viewed as either includingall claims assigned to the vehicle repair shop 108 (many vehicles) or byindividual claims.

For verification requests, the financial module 339 verifies that alltransaction information is accurate and associated to the correct claimnumbers. If errors are detected, the insurance company system 300 maylist the error messages on the “EFT Financials” screen and averification request may be submitted to the vehicle repair shop 108 tocorrect the error.

When the vehicle repair shop 108 starts the vehicle repair, the vehiclerepair shop 108 may enter the status change to “started” in theassignment screen 600. The status change may be transmitted via the weblink through the claim processing system 320 to be translated by thetranslation application 322 if needed. The status change may beregistered in the claims database 129. Once the vehicle repair shop 108completes the repair, a user at the vehicle repair shop 108 updates thevehicle repair shop workstation 107 to “vehicle delivered.” Theinsurance company system 300 then may transfer a status change by thesame process which will update the claim status in the claims database129 to “complete,” in turn authorizing the EFT system to make thepayment electronically. Therefore, there is no need for the vehiclerepair shop 108 to wait for payment by conventional methods such aschecks, etc. The EFT process may also begin when a user at the vehiclerepair shop 108 updates the vehicle repair shop workstation 107 to“vehicle delivered” or “repair complete.”

All transactions associated with the vehicle repair shop 108 or aparticular claim may be viewed 350 by the vehicle repair shop userand/or insurance company's claim representative to quickly determiningpayment status or issues.

Performance Module

In a step 222, a performance module 337 compiles vehicle repair shopperformance data, or Key Performance Indicator (KPI) data, thatcalculates a score and ranks the vehicle repair shop relative to othervehicle repair shops in the market. Finally, in a step 224, the VICMA330 gathers vehicle repair shop metrics by routing information throughthe claim processing translation system 322. The KPI data may becompiled for individual claim transactions. When all data fields arecaptured for a given claim, the claim file may be added to a vehiclerepair shop file that includes claim statistics for all claims thevehicle repair shop 108 has processed with the insurance company.

The vehicle repair shop file may include scores for customer service,repair quality (pass ratio), or cycle time. It may also include estimatemetrics that measure the vehicle repair shop's ability to estimate totalrepair cost, average part amount for estimate, and average hours perestimate (with a breakdown of refinish, repair, and replace). The reportmay also include a measure of estimate accuracy that measures thedifference between the vehicle repair shop's estimates and the finalbill, difference between submitted and reinspection results. Anotherquality criterion may measure the number of recommended certificationsthe vehicle repair shop has relative to the desired level ofcertification the insurance company has set or that the collision repairindustry has set as a desirable industry standard.

The insurance company system 300 and shop database 131 may compile theindividual vehicle repair shop files over a specified time (e.g., onemonth, six months, etc.) and then may calculate rankings relative to thelocal market. The report may be created and then viewed by the vehiclerepair shop 108 by linking through the web browser on the claimsprocessing application 332. The vehicle repair shop 108 may have onlyview-only rights 352 and may have no access for changing anyinformation. This aspect of the invention allows the performance module337 to gather performance metrics and automatically update the KPIperformance report when the individual claim files are completed. Theinvention further provides the vehicle repair shops 108 with the latestperformance rating and ranking feedback which may more quickly help themidentify ways to improve.

Illustrative User Interface

FIGS. 4-16 illustrate a set of illustrative user interface screens whichrepresent an aspect of the invention. Those skilled in the art willrecognize that these are only example user interface screens and that awide range and variety of user interface screens may be possible forthis invention. As used herein, the term “exemplary” is not intended tomean “best” or “ideal,” but rather is used synonymously with the term“illustrative.”

FIG. 4 illustrates an exemplary user interface screen 400 forauthentication 342 that may be presented to a user of the repair shopapplication 330. The authentication screen 400 may enable the user toenter their user name 402 and password 404. The user may then select a“Login” button 406 to begin the authentication process for the user ofthe VICMA 330.

FIGS. 5A and 5B illustrate exemplary “Assignments” user interfacescreens 502 for the present invention. On each of these “Home” screens530, the user may select any one of the following links across the topof the screen which will take the user to a specified action within theVICMA 330. These links may include: Assignments 500, Find Assignment1100, Request Assignment 1200, Financials 1300, Reinspections 1400, ShopProfile 1500, or Shop Performance 1600. Each of these categories will bedescribed in further detail below.

The user may select the “Assignments” link 500, the Assignment screen502 will be displayed. As illustrated in FIG. 5A, the transferred claimassignments may be listed in the Assignments screen 502. As illustratedin FIG. 5A, the following categories may be listed for each claimassignment: customer 504, vehicle 506, preferred phone 508, claim number510, date assigned 512, promised delivery date 514, and current status516. The user may also be able to change the status of a given claimthrough the “Change Status” link 518. The viewable list of claims may besorted by a category by selecting that given category area. Asillustrated in FIG. 5B, this exemplary interface screen 502 may havevarious views for the user. The user, from a drop-down selection box522, may select views such as: new, estimate complete, repair scheduled,repair started, repair complete, vehicle delivered, cancelled & closed,and all. In addition to the user having the ability to access and viewthis status information, others such as insurance agents, rental carcompanies, and customers may also have the ability to access and viewthis status information.

To view further assignment details for an individual claim or customer,the user may select a specific name 520 in the customer 504 category.FIG. 6 illustrates an exemplary user interface screen for AssignmentDetails 600. The Assignment Details screen 600 may list variousinformation which can include status, assignment type, date assigned,contact information, promised delivery data, notes to shop, shopcomments, claim number, named insured, loss date, loss type, loss typedetails, loss description, deductible amount, vehicle type, vehiclelocation, year/make/model, Vehicle Identification Number, license plate,damage description, prior damage, vehicle safety drivable, and rental.

Also on this assignment detail screen 600, the user may take variousactions associated with that specific claim. First, the user may selecta “Preload Assignment Data” button 602. When the “Preload AssignmentData” button 602 is selected, the assignment data is transferred fromthe claim processing database 324 to the VICMA 330. FIGS. 7A-7Cillustrate exemplary user interface screens for preloading assignmentdata 700. The preloading assignment data screen 700 lists the claimnumber 702 as well as the status of the transfer of the assignment data704 and the importing of assignment data 706.

Second, on FIG. 6, the assignment detail screen, the user may select an“Upload Estimate/Photo” button 604. When the “Upload Estimate/Photo”button 604 is selected, the VICMA 330 uploads the estimate from theclaim processing database 324 to the VICMA 330. In FIG. 8A, an exemplaryuser interface screen illustrates how the user may select the estimate800 and find the estimate 802 for a given claim number 804. Once theestimate is selected 800, in FIG. 8B, an exemplary user interface screenillustrates the system uploading the estimate 810. While uploading theestimate, the system obtains the estimate 812, validates the estimate814, translates the estimate 816, and reviews the estimate 818. A photomay also be uploading during this step along with the estimate.Furthermore, the user may also select the “Upload Photos Only” button606 in order to only upload photographs.

Third, on FIG. 6, the assignment detail screen 600, the user may selectto “Change Status/Dates” link 608. When the “Change Status/Dates” link608 is selected, the user may change the status of the claim assignmentor change various dates associated with the claim assignment on theChange Status/Dates user interface screen 900. Some examples of thedates which may be changed are: estimate complete date 902, repairscheduled date 904, repair started 906, promise delivery 908, repaircomplete 910, or vehicle delivered 912. Also on the Change Status/Datesscreen 900, the user may select the “Cancel Assignment” link 614.

Fourth, on FIG. 6, the assignment detail screen 600, the user may selectthe “Add Comments” link 610 which may allow the user to include commentssurrounding the particular claim assignment. Also, the user may selectthe “View History” link 612 which may allow the user to view the claimhistory from the initiation of the claim assignment through thecompletion of the claim assignment. Lastly, on the assignment detailscreen 600, the user may select the “Cancel Assignment” link 614 (thislink is the same as the “Cancel Assignment” link on FIG. 9) in order tocancel the selected claim assignment. FIG. 10 illustrates an exemplaryCancel Assignment user interface screen 1000. On this Cancel Assignmentscreen 1000, the user may select a reason from a “Cancellation Reason”drop-down menu 1002.

The user may select the “Find Assignment” link 1100 to search variousassignments on the Find Assignment screen 1102. FIG. 11 illustrates anexemplary Find Assignments user interface screen 1102. The FindAssignment screen 1102 may allow the user to search the claim database129 by customer last name 1104 or claim number. The VICMA 330 will thensearch the claim database 129 and list the search results 1106 and allclaim assignments which match the given search criteria.

The user may select the “Request Assignment” link 1200 to request anassignment on the Request Assignment screen 1202. FIG. 12 illustrates anexemplary Request Assignment user interface screen 1202. The RequestAssignment screen 1202 may allow the user to request a certainassignment by claim number 1204, customer name 1206, vehicle make 1208,or vehicle year 1210. The user may then select the “Request Assignment”button 1212 and the VICMA 330 will then search the claim database 129for the given claim request and then present the requested assignment onthe Assignment Details screen 600, as illustrated in FIG. 6.

The user may select the “Financials” link 1300 to display the Financialsscreen 1302. FIGS. 13A and 13B illustrate exemplary user interfacescreens for the financial module 339 of the VICMA 330. FIG. 13Aillustrates the Financial user interface screen 1302. The Financialscreen 1302 may allow the user to view a customer's financial status insuch categories as: customer name 1304, claim number 1306, lasttransaction date 1308, transaction type 1310 (e.g., remittance orverification), amount 1312, or status 1314. There may also be aselection for a “View All” link 1316 which allows the user to see thedetails of the financial customer or claim number. FIG. 13B illustratesthe specific details from the “View All” link 1316 for the claim number1320. On this screen, the following information is listed specificallyfor each financial transaction associated with the selected claimnumber: customer name 1322, transaction date 1324, transaction type 1326(e.g., remittance or verification), amount 1328, or status 1330.

The user may select the “Reinspection” link 1400 to display theReinspection Report screen 1402. FIG. 14A illustrates an exemplaryReinspection Report selection user interface screen 1402. TheReinspection Reports screen 1402 may list the available reinspectionreports for a given month. The user may select the month from a monthdrop-down menu 1404. After the user selects the month, the availablereinspection reports may be listed by: customer name 1406, claim number1408, reinspection date 1410, change request 1412, and estimate accuracy1414. A “View Detail” link 1416 may also be available for selection.FIG. 14B illustrates a reinspection report when the “View Detail” link1416 is selected. The reinspection report 1420 as illustrated in FIG.14B, may list general claim assignment details 1422, such as: ownername, reinspector name, estimate version, reinspection location,appraisal source, repair phase, reinspection type, reinspectioncomplete, or change request status. The reinspection report 1420 mayalso list the accuracy and opportunity 1424, such as: estimate accuracy(%), dollar accuracy (USD), opportunity (%), or dollar opportunity(USD). The reinspection report 1420 may also list the estimate line itemexceptions 1426, parts summary exceptions 1428, labor summary exceptions1430, material summary exceptions 1432, additional charges summaryexceptions 1434, or vehicle information exceptions 1436.

As illustrated in FIG. 15A, the user may select the Shop Profile userinterface screen 1500. The Shop Profile screen 1500 may list the storedetails of the selected shop 1502. The following information may belisted for each selected shop 1502: address, phone, e-mail, contactname, hours of operation, services, or closest major intersection. Theuser may also change the selected shop by selecting the “Change Shop”link 1504. After selecting the “Change Shop” link 1504, the user may betaken to a “Change Shop” user interface screen 1506 as illustrated inFIG. 15B. The user may select a vehicle repair shop by selecting theshop from a drop-down selection list 1508 with various shops listed fromthe shop database.

The user may select the “Shop Performance” link 1600 to display thePerformance screen 1602. FIG. 16 illustrates an exemplary ShopPerformance user interface screen 1602 from the Shop Performance module1600 on the VICMA 330. The Shop Performance screen 1602 may include boththe tier level 1604 and performance ranking (with “as of date”) 1606.The Performance screen 1602 may also include the following categories:customer service 1608, repair quality (e.g., pass ratio) 1610, cycletime 1612, estimate metrics 1614, reinspection accuracy 1616, andrecommended certifications (e.g., I-CAR, ASE Blue, SP2, etc.) 1618. Thecustomer service category may further include: explanation of shopprocess, quality of work, care and concern, timely completion ofrepairs, or promise time (e.g., change to delivered on time). Theestimate metrics category may further include: total repair cost,average part amount per estimate, average hours per estimate forrefinish, repair, and replace, or the difference from estimate to thefinal bill. Each of these categories may have its own shop result numberwith an associated ranking

Non-Referral Vehicle Repair Shops

Additionally, another illustrative embodiment provides a method andsystem for efficiently communicating data between an insurer and anon-referral repair shop, e.g., vehicle repair shops that are normallynot preapproved by the insurer to perform the estimating and repairwork. Non-referral vehicle repair shops may also be referred to asnon-direct repair shops. The methods and systems described herein areparticularly useful for insurers utilizing non-referral vehicle repairshops for servicing vehicles involved in insurance claims. In thisembodiment, the insured or claimant may be able to select a non-referralrepair shop, not delegated or preapproved by the insurer, therebyallowing the insured or claimant to select any vehicle repair shop. Aswas described above, this communicated information or data may includerepair estimates, photos, data regarding the insured party and/orvehicle, other data that may be used by a non-referral vehicle repairshop, and data obtained by a non-referral vehicle repair shop that issubsequently provided to the insurer. The term “photos” may refer tophotos in a variety of formats, including print or digital among others.

As one added benefit, this non-referral process will allow the customerto select a repair shop of their choice while reducing the insurancecompany's expense of hiring insurance adjustors. Generally, an insurancecompany may be required to utilize less insurance adjustors with thisembodiment of the non-referral module. Additionally, this process willsave the insured's time by not requiring the insured to visit aninsurance adjustor at a drive-in facility, or alternatively not havingto visit numerous vehicle repair facilities to secure multiple estimatesfor submission to the insurer.

As was described above, FIG. 1 illustrates one example of a networkarchitecture and data processing device that may be used to implementone or more aspects of the invention. Additionally, as was describedabove, one or more aspects of the invention may be embodied incomputer-usable data and computer-executable instructions, such as inone or more program modules, executed by one or more computers or otherdevices. Generally, program modules include routines, programs, objects,components, data structures, etc. that perform particular tasks orimplement particular abstract data types when executed by a processor ina computer or other device. The computer executable instructions may bestored on one or more computer readable media such as a hard disk,optical disk, removable storage media, solid state memory, RAM, etc. Aswill be appreciated by one of skill in the art, the functionality of theprogram modules may be combined or distributed as desired in variousembodiments. In addition, the functionality may be embodied in whole orin part in firmware or hardware equivalents such as integrated circuits,field programmable gate arrays (FPGA), and the like. Particular datastructures may be used to more effectively implement one or more aspectsof the invention, and such data structures are contemplated within thescope of computer executable instructions and computer-usable datadescribed herein.

In addition to the adapter module 336, the assignment module 326, thefinancial module 339, and the performance module 337, the VICMA 330 asdescribed above may also include a non-referral module 338. Thenon-referral module 338 may be defined by computer readable instructionsfrom the VICMA 330. The non-referral module 338 may comprise variousfunctions: rule based intelligence scores, desk intervention, fieldintervention, and/or change requests. FIG. 17 illustrates an insurancecompany system similar to the insurance system 300 illustrated in FIG. 3with the added non-referral module 338. The non-referral module 338 maybe part of the VICMA 330 as shown in FIG. 17. Without departing from thepresent invention, the non-referral module 338 may be part of orincluded with the insurance company system 300 as a separate module.

FIG. 18 illustrates a method for the VICMA 330 for use by an insurancecompany and a user of a computer system at a non-referral vehicle repairshop. The method illustrated in FIG. 18 will be described further in thefollowing exemplary embodiment.

In one embodiment of the present invention, in a first step 1802, afirst notice of loss (FNOL) is received by the insurance company fromthe insured. This FNOL may be received in the form of a phone call,email, website upload, or other methods applicable to the transfer ofinformation.

Following the FNOL, in a second step 1804, the insurance companyprovides options to the insured for fixing their vehicle. One optionwould be for the insured to take their vehicle to a direct repair shopas was described above. Another option would be for the insured toselect a non-referral repair shop for the repairs. A non-referral repairshop may be defined as not delegated or preapproved by the insurancecompany, thereby generally allowing the insured to select any availablevehicle repair shop. In some instances, a repair shop may be chosen bythe insured which is neither a referral shop nor a non-referral shop. Inthis instance, the insurance company may opt to send a field adjuster toinspect the damage to the vehicle or other methods as included with thisinvention or outside of this invention. Many reasons or factors may beutilized in an insured selecting a non-referral repair shop. First, anon-referral repair shop may be geographically closer to the insured andit may be more convenient to have their vehicle repaired at anon-referral repair shop. Second, the insured may have an existingpositive relationship with a non-referral repair shop. In this instance,the insured may feel more comfortable having their vehicle repaired atthe non-referral repair shop versus a repair shop recommended by theinsurance company. Third, there may not be any direct repair shops inthe insured's area and therefore, the only possible repair shop would bea non-referral repair shop. Following the selection from the insured,the VICMA 330 may determine whether the repair shop selected is a directrepair shop or a non-referral repair shop. As was stated above, if theinsured selects a direct repair shop, the VICMA 330 proceeds as wasdescribed above, specifically in FIGS. 2A and 2B. If the insured selectsa non-referral repair shop, the VICMA 330 proceeds as will be describedbelow for a non-referral repair shop.

The VICMA 330 may include the ability to recognize that the repair shopselected is a participating non-referral repair shop. When thisparticipating non-referral repair shop is identified, the VICMA 330 maysend the assignment to the non-referral repair shop. Similarly to as wasdescribed above for direct repair shops, the present invention mayprovide the non-referral repair shop with assignment data needed toprepare a repair estimate or repair the vehicle. Assignment data mayinclude, but not be limited to, customer name, contact information,insurance claim number, assignment date, loss date, loss type, loss typedetail, loss description, current vehicle location, location wherevehicle may be sent, deductible amount, vehicle type, year/make/model,vehicle identification number (VIN), license plate number, towingcompany information, damage information, prior damage information, andvehicle safety status (drivable/non-drivable).

Additionally, in the second step 1804, a market relationship manager mayallow the input of the non-referral repair shops. The marketrelationship manager may generally be a repository of information usedin the management of repair shops, both non-referral repair shops anddirect repair shops. The market relationship manager may also allow thecreation of non-referral multi-shop organizations. The non-referralmulti-shop organization may include the ability to group commonly-ownedrepair shops, such that a set of repair shops that are commonly-ownedare grouped together. Additionally, the market relationship manager mayallow for the conversion between referral repair shops (or direct repairshop) and non-referral repair shops.

In a third step 1806, the VICMA 330 and non-referral module 338determines if the non-referral repair shop is in a staffed market or anon-staffed market. A staffed market may be defined as a market or areawhere field adjusters are available to make field inspections (as willbe described below). A non-staffed market may be defined as a market orarea where there are no field adjusters present or available in thearea.

In a fourth step 1808, the VICMA 330 and non-referral module 338 receivean estimate uploaded from the non-referral repair shop. During thisstep, the non-referral repair shop receives the assignment data from theinsurance company and then completes the estimate for the vehiclerepair. The non-referral module 338 may include rules and activities toensure that the customer-repair shop completes and uploads the estimatefor the vehicle repair in a required amount of time defined as a futuredisplay date. In one illustrative aspect, in a staffed market, if theestimate is not uploaded prior to the future display date, thenon-referral repair shop assignment may be canceled. Further, after thenon-referral repair shop estimate assignment is canceled, a fieldestimate assignment may be assigned to a field adjuster in the staffedmarket. In another illustrative aspect, in a non-staffed market, if theestimate is not uploaded prior to the future display date, an automatedtask may be established to contact the non-referral repair shop and/orinsured to ensure the estimate is completed in a timely manner.

In a fifth step 1810, after the estimate is transferred to the insurancecompany system 300, the VICMA 330 and the non-referral module 338 mayanalyze and/or audit the estimate and calculate a score or rules-basedintelligence (RBI) points for the estimate. The RBI points arecumulative for the subject estimate and any supplement estimateversions. The analysis/audit and calculation may include a line-by-linereview of the estimate, such as “Repair Fender” and “Paint Fender.”Additionally, the analysis and calculation may include a review of theestimate in aggregate, such as the total number of labor hours or thetotal parts costs.

The VICMA includes a proprietary set of rules that serve to audit theestimate both on the front and back end, i.e. front end rules and backend rules. The front end rules are used to alert the appraiser of errorsor omissions in the preparation of the estimate and provide anopportunity for the appraiser to amend the estimate. Each back end rulemay be assigned a RBI point value. The total of back end rules generatedproduces a cumulative RBI score for each estimate and any supplementestimate version. These back end rules may be generally related to andfocused on identifying anomalies in an estimate. The individualproprietary set of rules may be based on and developed from anecdotal orexperience from experienced damage evaluators or previous staffadjusters during their re-inspections. Additionally, the proprietary setof rules, exceptions, exclusions, and/or prioritizations may includestatistically-based analysis of historical data. One illustrative ruleor exception may be when the Chicago labor rate is known to beapproximately $44-46 and the labor rate on the estimate is listed as$80. Another illustrative rule or exception may be for a drivablevehicle with an estimate for the hours of labor to repair the frame,where the appraised number of hours to repair the frame may beinconsistent with the typical damage to a drivable vehicle.

Following the calculation of the RBI points for the estimate, in a sixthstep 1812, the VICMA 330 and the non-referral module 338 may determinethe intervention level for the estimate. First, the intervention levelmay include three different levels: automatic approval 1813A, deskintervention 1813B, and field intervention 1813C. With the automaticapproval 1813A, the VICMA 330 and the non-referral module 388automatically approves the estimate. The desk intervention level 1813Bis defined by a review and/or approval by a desk intervention adjusteror inside technical reviewer. The field intervention level 1813C isdefined by a review and/or approval by a field adjuster. Further detailsof each of these intervention levels will be defined below.

To determine the intervention level, the VICMA 330 and non-referralmodule 338 analyze the RBI score and whether the non-referral repairshop is in a staffed market or a non-staffed market. In determining theintervention level, the RBI score may be in a low-range, mid-range, orhigh-range. The ranges can be configured by the insurance company at anindividual market level. Separate ranges can be established forcatastrophe and non-catastrophe claims. Without departing from thepresent invention, the low-range, mid-range, and high-range may bedetermined and adjusted during the process by the insurance company.

Additionally, these threshold settings of low-range, mid-range, andhigh-range may be configurable based on the changing market conditionsand changes in the market and/or environment. The configurability of thethreshold settings of low-range, mid-range, and high-range may beperformed manually or automatically. A rule set editor application mayautomatically provide these market configurable threshold settings usedfor estimate routing and determining the intervention level based onchanges in the market condition and environment.

According to aspects of the present invention, if the RBI score islow-range, the VICMA 330 and non-referral module 338 may determine anautomatic approval intervention level 1813A. When the RBI score islow-range, the intervention level of an automatic approval 1813A is notdependent on whether the non-referral repair shop is in a staffed marketor a non-staffed market. Additionally, when the RBI score is mid-range,the VICMA 330 and the non-referral module 338 may determine a deskintervention level 1813B. When the RBI score is mid-range, theintervention level of desk intervention 1813B is not dependent onwhether the non-referral repair shop is in a staffed market or anon-staffed market. These mid range RBI scored estimates are routed to aqueue where the estimates may be held for review by the technicalreviewer. When the RBI score is high-range and the non-referral repairshop is in a staffed market, the VICMA 330 and the non-referral module338 may determine a field intervention 1813C. These high range RBIscored estimates may be routed to a queue where they are dispatched toan field adjuster. However, when the RBI score is high-range and thenon-referral repair shop is in a non-staffed market, the VICMA 330 andthe non-referral module 338 may determine a desk intervention 1813B,thereby automatically routing the claim to the desk review queue anddesignated the claim as a non-staffed area. Additionally, other factorsand additional level determinations may be made when determining theintervention level without departing from the present invention.

After the intervention level is determined, the intervention may becompleted as was determined in step 1812. For automatic approval 1813A,the VICMA 330 or non-referral module 338 may automatically approve theestimate for the non-referral repair shop such that the non-referralrepair shop may then begin repairs of the damaged vehicle. An automatedstatus may be sent to the non-referral repair shop advising that theestimate has been approved.

For desk intervention 1813B, a desk intervention adjuster orinternal/inside technical reviewer may review and analyze the estimate,photos, assignment, etc. for accuracy and errors. The inside technicalreviewer may determine that the vehicle is a total loss wherein thetotal loss may then be handled as those processes and methods as knownand used in the art. Additionally, the inside technical reviewer maydetermine that a field inspection is needed if there is a lack ofdetailed information in the estimate, photos, or assignment or if theinside technical reviewer feels that this estimate and vehicle need tobe reviewed in person. If a field inspection is needed, the estimate andassignment may be sent, by way of the desk review queue to the Fieldqueue, to the field intervention step 1813C and a field interventionadjuster as will be described below in step 1813C. Additionally theinside technical reviewer may determine that changes are required forthe estimate. If changes are required, a change request process willbegin as will be described below in step 1814. If the vehicle is not atotal loss, a field inspection is not needed, and no changes arerequired, the inside technical reviewer may then approve the estimatefor the non-referral repair shop such that the non-referral repair shopmay then begin repairs of the damaged vehicle.

For field intervention 1813C, a field intervention adjuster (which mayalso be labeled as field adjuster) may review both the non-referralrepair shop and the vehicle. The field adjuster typically performs aphysical inspection of the vehicle and may also review and analyze theestimate, photos, assignment, etc. for correctness and errors. Theinside technical reviewer may determine that the vehicle is a total losswherein the total loss may then be handled as those processes andmethods as known and used in the art. Additionally, the field adjustermay determine that changes are required for the estimate. If changes arerequired, a change request process will begin as will be described belowin step 1814. If the vehicle is not a total loss and no changes arerequired, the field adjuster may then approve the estimate for thenon-referral repair shop such that the non-referral repair shop may thenbegin repairs of the damaged vehicle. Without departing from the presentinvention, the field adjuster may approve the estimate by using a mobilecommunication device through a mobile client application from thenon-referral repair shop or another remote location.

In a seventh step 1814, the VICMA 330 and non-referral module 338 mayprocess a review or change request when required or needed. With thechange request, the adjuster (either a desk intervention adjuster orfield adjuster as applicable) may attempt to reach an agreed price withthe non-referral repair shop. If the desk intervention adjuster cannotreach the agreed price with the non-referral repair shop, theassignment/estimate may be sent to a field intervention adjuster forphysical inspection and potential adjustment/changes. Theassignment/estimate may be routed from the desk review queue to thefield queue. If the field intervention adjuster cannot reach an agreedprice with the non-referral repair shop, the assignment/estimate may becancelled from the non-referral repair shop and the field adjuster maythen create an estimate from one of the various estimating platformproducts known and used in the art. This new estimate may then betreated in the same manner as a regular field assignment/estimate asdescribed above.

However, if the adjuster is able to reach an agreed price with thenon-referral repair shop, the adjuster and/or the non-referral module338 may create a change request. The VICMA 330 and non-referral module338 may then transfer the change request to the non-referral repairshop. After the non-referral repair shop addresses the change requestand makes the appropriate changes to the estimate, the non-referralrepair shop uploads and transfers the revised estimate back to the VICMA330 (and/or the non-referral module at the insurance company) byelectronically sending the revised estimate to a “reconciliation queue”.Again, the adjuster (either a desk intervention adjuster or fieldadjuster as applicable) may review the revised estimate from thenon-referral repair shop. If the adjuster agrees with the revisedestimate from the non-referral repair shop, the adjuster may approve thenew estimate. However, if the adjuster does not agree with the revisedestimate from the non-referral repair shop, the adjuster submits a newchange request via the VICMA 330 and through the non-referral module 338and the above steps are repeated.

Many external systems and components may provide additional features toaspects of this invention. For example, an external server or clientserver may add the functionality of sending the non-referral reviewrequests throughout the process. Additionally this external server mayassist and allow the approval of the non-referral estimates via theVICMA 330. This external server may be for example a mobile clientmanagement system.

Additionally, a scheduler application may allow the added functionalityof identifying the non-referral and the referral shop locations from afield user interface. Based on this identification, the schedulerapplication may launch or enter the identification into the appropriateassignments, i.e. non-referral assignments or referral assignments.

Additionally, a plurality of estimate routing rules may be utilized bythe VICMA 330. These estimate routing rules may define circumstances forrouting the estimate based on the original estimate, supplements,conversions, change requests, and/or total losses. Other routing rulesmay be utilized without departing from this invention. Additionally,additional work queues or database files may be utilized to serve asrepositories for specific estimates based on these estimate routingrules.

CONCLUSION

Although the subject matter has been described in language specific tostructural features and/or methodological acts, it is to be understoodthat the subject matter defined in the appended claims is notnecessarily limited to the specific features or acts described above.Rather, the specific features and acts described above are disclosed asexample forms of implementing the claims.

What is claimed is:
 1. An insurance claim system for improvedinteroperability between an insurance company data server and a vehiclerepair estimating system to efficiently communicate data between aninsurer and a non-referral repair shop, the system comprising: a workrequest submitted to a non-referral vehicle repair shop, wherein thenon-referral vehicle repair shop is not included within a pre-approvedshop network associated with an insurance company, the work requestincluding a set of assignment data with information about a customer, acorresponding vehicle, and a corresponding loss with the vehicle; aninsurance company data server at the insurance company comprising atleast one computer processor and a user interface and coupled to anetwork, wherein the user interface includes an assignment userinterface and an authentication user interface to enable the customer toenter a user name and a password; a vehicle repair estimating systemhaving at least one computer processor and interconnected with theinsurance company data server via the network, the vehicle repairestimating system creating a vehicle repair estimate, wherein the repairestimate includes a set of estimate data and an image of thecorresponding loss and damage of the vehicle; and a vehicle insuranceclaim management application operating on the insurance company dataserver and the vehicle repair estimating system and executing a specificsequence of steps with the insurance company data server and the vehiclerepair estimating system that causes the insurance claim system to:receive the work request and the set of assignment data from theinsurance company data server via the assignment user interface, receivethe vehicle repair estimate with the set of estimate data and the imagefrom the non-referral vehicle repair shop, wherein the vehicle repairestimate is uploaded from the vehicle repair estimating system to thevehicle insurance claim management application, translate and change theset of estimate data and the image into a format accepted by the vehicleinsurance claim management application, wherein the translating includesencrypting the set of estimate data and the image, calculate arules-based intelligence score based on an analysis and audit of the setof estimate data, wherein the rules-based intelligence score is relatedto an identification of anomalies in the set of estimate data andincludes a statistically-based analysis of historical estimate data,determine a 3-tier intervention for the set of estimate data based onthe rules-based intelligence score by the comparing the rules-basedintelligence score to one of a low-range, mid-range, or high-rangethreshold, wherein the 3-tier intervention includes a first interventionof an automatic approval, a second intervention of a desk intervention,and a third intervention of a field intervention, and wherein thelow-range, mid-range, and high-range threshold is determined andadjusted by the vehicle insurance claim management application, andfurther wherein the low-range, mid-range, and high-range threshold isconfigurable, provide real-time updates between the vehicle insuranceclaim management application and the vehicle repair estimating systemwhen one or more of the estimate data, the assignment data, therules-based intelligence score, or the intervention changes, transmitand communicate, over the Internet to the vehicle insurance claimmanagement application and displayed on the user interface, thereal-time updates of changes to one or more of the estimate data, theassignment data, the rules-based intelligence score, or theintervention, wherein if the rules-based intelligence score correlatesto the low-range threshold and the first intervention being theautomatic approval, then the processor approves the vehicle repairestimate, wherein if the rules-based intelligence score correlates tothe mid-range threshold and to the second intervention being the deskintervention, then the processor transfers the vehicle repair estimateto a desk adjuster for a desk review and the processor further receivesone of an approved estimate from the desk adjuster or a disapprovedestimate from the desk adjuster, and wherein if the rules-basedintelligence score correlates to the high-range threshold and to thethird intervention being the field intervention, then the processortransfers the vehicle repair estimate to a field adjuster for a fieldreview and the processor further receives one of the approved estimatefrom the field adjuster or the disapproved estimate from the fieldadjuster.
 2. The insurance claim system of claim 1, wherein thedetermination of the rules-based intelligence score includes aline-by-line review of the set of estimate data.
 3. The insurance claimsystem of claim 1, wherein the determination of the rules-basedintelligence score includes an aggregate review of the set of estimatedata.
 4. The insurance claim system of claim 1, wherein the vehicleinsurance claim management application operating on the insurancecompany data server and the vehicle repair estimating system andexecuting a specific sequence of steps with the insurance company dataserver and the vehicle repair estimating system causes the insuranceclaim system further to: store and provide payment status informationfor the plurality of work requests assigned to the non-referral vehiclerepair shop.
 5. The insurance claim system of claim 1, wherein thevehicle insurance claim management application operating on theinsurance company data server and the vehicle repair estimating systemand executing a specific sequence of steps with the insurance companydata server and the vehicle repair estimating system causes theinsurance claim system further to: store and provide one or moreperformance metrics for the non-referral vehicle repair shop as comparedto other vehicle repair facilities working with the insurance company.6. The insurance claim system of claim 1, wherein the insurance companydata server is coupled to a web server through which users interact withthe vehicle insurance claim management application and the insuranceclaim system.
 7. The insurance claim system of claim 6, wherein the webserver includes a claim processing system used to store the set ofassignment data for further processing.
 8. The insurance claim system ofclaim 1, wherein the vehicle insurance claim management applicationoperating on the insurance company data server and the vehicle repairestimating system and executing a specific sequence of steps with theinsurance company data server and the vehicle repair estimating systemcauses the insurance claim system further to: provide a timelineindicating a plurality of milestone dates corresponding to a displayedvehicle work request.
 9. An insurance claim system for improvedinteroperability between an insurance company data server and a vehiclerepair estimating system to efficiently communicate data between aninsurer and a non-referral repair shop, the system comprising: a firstwork request submitted to a direct repair vehicle repair shop, the firstwork request including a first set of assignment data with informationabout a first customer, a corresponding first vehicle, and acorresponding first loss with the first vehicle; a second work requestsubmitted to a non-referral vehicle repair shop, wherein thenon-referral vehicle repair shop is not included within a pre-approvedshop network associated with an insurance company, the second workrequest including a second set of assignment data with information abouta second customer, a corresponding second vehicle, and a correspondingsecond loss with the second vehicle; an insurance company data servercomprising at least one computer processor and a user interface andcoupled to a network, wherein the user interface includes an assignmentuser interface and an authentication user interface to enable the firstcustomer and the second customer to enter a user name and password; afirst vehicle repair estimating system having at least one computerprocessor and interconnected with the insurance company data server viathe network, the first vehicle repair estimating system creating a firstvehicle repair estimate that includes a first set of estimate data and afirst image of the corresponding first loss and damage of the firstvehicle; a second vehicle repair estimating system having at least onecomputer processor and interconnected with the insurance company dataserver via the network, the second vehicle repair estimating systemcreating a second vehicle repair estimate that includes a second set ofestimate data and a second image of the corresponding second loss anddamage of the second vehicle, wherein the second vehicle repairestimating system is different than the first vehicle repair estimatingsystem; and a vehicle insurance claim management application operatingon the insurance company data server, the first vehicle repairestimating system, and the second vehicle repair estimating system andexecuting a specific sequence of steps with the insurance company dataserver, the first vehicle repair estimating system, and the secondvehicle repair estimating system that causes the insurance claim systemto: receive the first work request and the first set of assignment datafrom the insurance company data server via the assignment userinterface; translate and change the first set of assignment data into aformat accepted by the vehicle insurance claim management application;transfer the translated first set of assignment data to the firstvehicle repair estimating system; receive the first vehicle repairestimate with the first set of estimate data and the first image fromthe first vehicle repair estimating system, wherein the first vehiclerepair estimate is uploaded from the first vehicle repair estimatingsystem to the vehicle insurance claim management application; translateand change the first set of estimate data into a format accepted by thevehicle insurance claim management application; review the translatedfirst set of estimate data and the first image for compliance with a setof contract-based conditions; receive the second work request and thesecond set of assignment data from the insurance company data server viathe assignment user interface; translate and change the second set ofassignment data into a format accepted by the vehicle insurance claimmanagement application; transfer the translated second set of assignmentdata to the second vehicle repair estimating system; receive the secondvehicle repair estimate with the second set of estimate data and thesecond image from the second vehicle repair estimating system, whereinthe second vehicle repair estimate is uploaded from the second vehiclerepair estimating system to the vehicle insurance claim managementapplication; translate and change the second set of estimate data andthe second image into a format accepted by the vehicle insurance claimmanagement application; calculate a rules-based intelligence score basedan analysis and audit of on the second set of estimate data, wherein therules-based intelligence score is related to an identification ofanomalies in the second set of estimate data and includes astatistically-based analysis of historical estimate data; determine a3-tier intervention for the second set of estimate data based on therules-based intelligence score by the comparing the rules-basedintelligence score to one of a low-range, mid-range, or high-rangethreshold, wherein the 3-tier intervention includes a first interventionof an automatic approval, a second intervention of a desk intervention,and a third intervention of a field intervention, and wherein thelow-range, mid-range, and high-range threshold is determined andadjusted by the vehicle insurance claim management application, andfurther wherein the low-range, mid-range, and high-range threshold isconfigurable; provide real-time updates between the vehicle insuranceclaim management application, the first vehicle repair estimatingsystem, and the second vehicle repair estimating system when one or moreof the estimate data, the assignment data, the rules-based intelligencescore, or the intervention changes; and transmit and communicate, overthe Internet to the vehicle insurance claim management application, thereal-time updates of changes to one or more of the estimate data, theassignment data, the rules-based intelligence score, or theintervention, wherein if the second set of estimate data and therules-based intelligence score correlates to the low-range threshold andthe first intervention being the automatic approval, then the processorapproves the second vehicle repair estimate, wherein if the second setof estimate data and the rules-based intelligence score correlates tothe mid-range threshold and the second intervention being the deskintervention, then the processor transfers the second vehicle repairestimate to a desk adjuster for a desk review and the processor furtherreceives one of an approved estimate data from the desk adjuster or adisapproved estimate data from the desk adjuster, and wherein if thesecond set of estimate data and the rules-based intelligence scorecorrelates to the high-range threshold and the third intervention beingthe field intervention, then the processor transfers the second vehiclerepair estimate to a field adjuster for a field review and the processorfurther receives one of the approved estimate data from the fieldadjuster or the disapproved estimate data from the field adjuster. 10.The insurance claim system of claim 9, wherein the determination of therules-based intelligence score includes a line-by-line review of thesecond set of estimate data and an aggregate review of the second set ofestimate data.
 11. The insurance claim system of claim 9, wherein thevehicle insurance claim management application operating on theinsurance company data server, the first vehicle repair estimatingsystem, and the second vehicle repair estimating system and executing aspecific sequence of steps with the insurance company data server, thefirst vehicle repair estimating system, and the second vehicle repairestimating system causes the insurance claim system further to: storeand provide payment status information for the plurality of vehicle workrequests assigned to the direct repair vehicle repair shops and thenon-referral repair shops.
 12. The insurance claim system of claim 9,wherein the vehicle insurance claim management application operating onthe insurance company data server, the first vehicle repair estimatingsystem, and the second vehicle repair estimating system and executing aspecific sequence of steps with the insurance company data server, thefirst vehicle repair estimating system, and the second vehicle repairestimating system causes the insurance claim system further to: storeand provide a performance metric for the direct repair vehicle repairshops as compared to other vehicle repair facilities working with theinsurance company.
 13. The insurance claim system of claim 9, whereinthe insurance company data server is coupled to a web server throughwhich users interact with the vehicle insurance claim managementapplication and the insurance claim system.
 14. The insurance claimsystem of claim 13, wherein the web server includes a claim processingsystem used to store the first and second set assignment data forfurther processing.
 15. The insurance claim system of claim 9, whereinthe vehicle insurance claim management application operating on theinsurance company data server, the first vehicle repair estimatingsystem, and the second vehicle repair estimating system and executing aspecific sequence of steps with the insurance company data server, thefirst vehicle repair estimating system, and the second vehicle repairestimating system causes the insurance claim system further to: providean interactive calendar through which the direct repair vehicle repairshops and the non-referral repair shops schedule repair of a vehiclecorresponding to a displayed vehicle work request.
 16. An insuranceclaim system for improved interoperability between an insurance companydata server and a vehicle repair estimating system to efficientlycommunicate data between an insurer and a non-referral repair shop, thesystem comprising: a first work request submitted to a direct repairvehicle repair shop, the first work request including a first set ofassignment data with information about a first customer, a correspondingfirst vehicle, and a corresponding first loss with the first vehicle; asecond work request submitted to a non-referral vehicle repair shop,wherein the non-referral vehicle repair shop is not included within apre-approved shop network associated with an insurance company, thesecond work request including a second set of assignment data withinformation about a second customer, a corresponding second vehicle, anda corresponding second loss with the second vehicle; an insurancecompany data server comprising at least one computer processor and auser interface and coupled to a network, wherein the user interfaceincludes an assignment user interface and an authentication userinterface to enable the first customer and the second customer to entera user name and password; a vehicle repair estimating system having atleast one computer processor and interconnected with the insurancecompany data server via the network, the vehicle repair estimatingsystem creating a first vehicle repair estimate and a second vehiclerepair estimate, wherein the first vehicle repair estimate includes afirst set of estimate data and a first image of the corresponding firstloss and damage of the first vehicle, and further wherein the secondvehicle repair estimate includes a second set of estimate data and asecond image of the corresponding second loss and damage of the secondvehicle; a vehicle insurance claim management application incommunication with the insurance company data server and the vehiclerepair estimating system that causes the insurance claim system to:receive the first work request and the first set of assignment data fromthe insurance company data server via the assignment user interface;translate and change the first set of assignment data into a formataccepted by the vehicle insurance claim management application; transferthe translated first set of assignment data to the vehicle repairestimating system; receive the first vehicle repair estimate with thefirst set of estimate data and the first image from the vehicle repairestimating system, wherein the first vehicle repair estimate is uploadedfrom the vehicle repair estimating system to the vehicle insurance claimmanagement application; translate and change the first set of estimatedata and the first image into a format accepted by the vehicle insuranceclaim management application; review the first set of estimate data andthe first image for compliance with a set of contract-based conditions;receive the second work request and the second set of assignment datafrom the insurance company data server via the assignment userinterface; translate and change the second set of assignment data into aformat accepted by the vehicle insurance claim management application;transfer the translated second set of assignment data to the vehiclerepair estimating system; receive the second vehicle repair estimatewith the second set of estimate data and the second image from thevehicle repair estimating system, wherein the second vehicle repairestimate is uploaded from the vehicle repair estimating system to thevehicle insurance claim management application; translate and change thesecond set of estimate data and the second image into a format acceptedby the vehicle insurance claim management application; calculate arules-based intelligence score based on an analysis and audit of thesecond set of estimate data, wherein the rules-based intelligence scoreis related to an identification of anomalies in the second set ofestimate data and includes a statistically-based analysis of historicalestimate data; determine a 3-tier intervention for the second set ofestimate data based on the rules-based intelligence score by thecomparing the rules-based intelligence score to a low-range, mid-range,or high-range threshold, wherein the 3-tier intervention includes afirst intervention of an automatic approval, a second intervention of adesk intervention, and a third intervention of a field intervention, andwherein the low-range, mid-range, and high-range threshold is determinedand adjusted by the vehicle insurance claim management application, andfurther wherein the low-range, mid-range, and high-range threshold isconfigurable; provide real-time updates between the vehicle insuranceclaim management application, the first vehicle repair estimatingsystem, and the second vehicle repair estimating system when one or moreof the estimate data, the assignment data, the rules-based intelligencescore, or the intervention changes; and transmit and communicate, overthe Internet to the vehicle insurance claim management application, thereal-time updates of changes to one or more of the estimate data, theassignment data, the rules-based intelligence score, or theintervention.
 17. The insurance claim system of claim 16, wherein thedetermination of the rules-based intelligence score includes aline-by-line review of the second set of estimate data and an aggregatereview of the second set of estimate data.
 18. The insurance claimsystem of claim 16, wherein if the second set of estimate data and therules-based intelligence score correlates to the low-range threshold andthe first intervention being the automatic approval, then the processorapproves the second vehicle repair estimate.
 19. The insurance claimsystem of claim 16, wherein if the second set of estimate data and therules-based intelligence score correlates to the mid-range threshold andthe second intervention being the desk intervention, then the processortransfers the second vehicle repair estimate to a desk adjuster for adesk review and the processor further receives one of an approvedestimate data from the desk adjuster or a disapproved estimate data fromthe desk adjuster.
 20. The insurance claim system of claim 16, whereinif the second set of estimate data and the rules-based intelligencescore correlates to the high-range threshold and the third interventionbeing the field intervention, then the processor transfers the secondvehicle repair estimate to a field adjuster for a field review and theprocessor further receives one of the approved estimate data from thefield adjuster or the disapproved estimate data from the field adjuster.